In­te­grat­ing care, cut­ting costs

Hospi­tal lead­ers have spent years in an unset­tled en­vi­ron­ment talk­ing about in­te­grated care, but 2013 could mark a key year when of­fi­cials fol­low through on those con­ver­sa­tions and make sig­nif­i­cant head­way in im­prov­ing ef­fi­ciency through new de­liv­ery models.

Suc­cess­ful or­ga­ni­za­tions will make sure staff is bet­ter en­gaged, says Thomas Dolan, pres­i­dent and CEO of the Amer­i­can Col­lege of Health­care Ex­ec­u­tives. Physi­cians play a crit­i­cal role, and sys­tem and hospi­tal ex­ec­u­tives will need to find new ways to col­lab­o­rate ef­fec­tively with them, en­sur­ing they’re on the same page as more ac­count­able care or­ga­ni­za­tions and pa­tient-cen­tered med­i­cal homes are es­tab­lished in the months ahead.

Com­mu­ni­ca­tion with staff is key, Dolan says, be­cause there’s a good chance per­son­nel will be re­duced as providers con­tinue the shift to­ward am­bu­la­tory ser­vices. That’s a pre­dic­tion echoed by the coun­try’s largest nurses union, Na­tional Nurses United, es­pe­cially since la­bor is a health­care or­ga­ni­za­tion’s largest cost.

“Hos­pi­tals and health in­surance com­pa­nies are try­ing to fig­ure out how” the Pa­tient Pro­tec­tion and Af­ford­able Care Act is go­ing to af­fect the bot­tom line, says NNU Co-pres­i­dent Deb­o­rah Burger. “And they’re try­ing to fig­ure out how to max­i­mize their prof­its by do­ing ev­ery­thing they can to re­struc­ture how health­care is pro­vided.”

At the same time, fur­ther im­ple­men­ta­tion of Six Sigma and Lean strate­gies, cou­pled with other process-im­prove­ment tech­niques for cut­ting costs, will con­tinue to grab a lot of at­ten­tion from hospi­tal ad­min­is­tra­tors, Dolan says.

“The No. 1 story is the con­tin­u­ous quest to re­duce costs and in­te­grate care,” he says.

Hos­pi­tals will con­tinue to ac­quire physi­cian prac­tices as they work to en­sure a strong con­tin­uum of care to mesh with pro­vi­sions of the Af­ford­able Care Act that are ex­pected to boost pa­tient vol­ume. Med­i­caid ex­pan­sion un­der the ACA could add as many as 30 mil­lion en­rollees un­der the pro­gram start­ing in 2014, driv­ing de­mand for physi­cian ser­vices, es­pe­cially in pri­mary care.

Dolan has an­nounced he will step down in May, and last week the ACHE named Deb­o­rah Bowen, the group’s ex­ec­u­tive vice pres­i­dent and chief op­er­at­ing of­fi­cer, as his suc­ces­sor. More health­care or­ga­ni­za­tions could be mak­ing sim­i­lar tran­si­tions in the C-suite. Ex­ec­u­tive turnover is likely to in­crease in 2013 as more baby boomers re­tire, Dolan says. The most re­cent ACHE data shows hospi­tal CEO turnover held steady in 2010 and 2011 at 16%, but Dolan says he wouldn’t be sur­prised if that rate in­creases to 18%, which is where it stood in 2009 when hospi­tal CEO turnover hit an all-time high.

Be­yond CEOs, in­creased ex­ec­u­tive turnover at all lev­els also could be a symp­tom of ap­point­ing a se­nior-level re­place­ment from out­side the or­ga­ni­za­tion, Dolan says. Not only can such tran­si­tions cause re­sent­ment from staffers who per­ceive they weren’t given a fair shot at a pro­mo­tion, but also some­times the re­place­ment ex­ec­u­tive just isn’t a good fit. Be­cause they aren’t as fa­mil­iar with the sys­tem or hospi­tal, those new hires can re­quire a longer learn­ing curve com­pared with an in­ter­nal can­di­date who is more com­fort­able with the or­ga­ni­za­tion’s poli­cies and cul­ture.